Sustained release compositions for treating periodontal disease

ABSTRACT

This invention relates to compositions/devices and methods for treating diseases of the oral cavity in humans and lower animals using polypropenoic acid compositions/devices for releasing drugs in the oral cavity.

This is a continuation of application Ser. No. 438,545 filed Nov. 17,1989, now U.S. Pat. No. 5,084,267.

TECHNICAL FIELD

This invention relates to compositions/devices for treating diseases ofthe oral cavity, which compositions/devices are placed in or around theperiodontal pocket. The invention also relates to methods of using thecompositions/devices in humans and lower animals suffering from suchdiseases.

Periodontal disease, for example, is a major cause of tooth loss inadults. Tooth loss from periodontal disease is a significant problembeginning at age 35, but even by age 15 it is estimated that about 4 outof 5 persons already have gingivitis and 4 out of 10 have periodontitis.

While good oral hygiene, as achieved by brushing the teeth with acleansing dentifrice, may help reduce the incidence of periodontaldisease, it does not necessarily prevent or eliminate its occurrence.This is because microorganisms contribute to both the initiation andprogress of periodontal disease. Thus, in order to prevent or treatperiodontal disease, these microorganisms must be suppressed by somemeans other than simple mechanical scrubbing. Towards this end, therehas been a great deal of research aimed at developing therapeuticdentifrices, mouthwashes, and methods of treating periodontal diseasewhich are effective in suppressing these microorganisms.

Recent developments in the art are directed toward delivering thetherapeutic agent directly to the periodontal pocket, in some cases in acontrolled release formulation. Gordon et al. have described the use ofa drug-filled polymer hollow fiber. (J. M. Goodson et al., "PeriodontalTherapy by Local Delivery of Tetracycline", J. Clin. Periodontal. 6, 83(1979), J. Lindhe et al., "Local Tetracycline Delivery Using HollowFiber Devices in Periodontal Therapy", J. Clin. Periodontal. 6, 141(1979) and R. L. Dunn et al., "Monolithic Fibers for Controlled Deliveryof Tetracycline", in Proc. Ninth Int. Symposium on Controlled Release ofBioactive Materials. Ft. Lauderdale, Fla., July (1982). This device istied around a tooth and gently pressed below the margin of the gingivaso that it resides in the periodontal pocket, and is capable ofdelivering an effective dose of 2.5 micrograms of tetracycline per dayper periodontal pocket for a prolonged period of a week or more. Similarresults have been obtained by Coventry and Newman (J. Coventry and H. N.Newman, "Experimental Use of a Slow Release Device EmployingChlorhexidine Gluconate in Areas of Acute Periodontal Inflammation", JClin. Periodontal. 9, 129 (1982) and Addy et al. (M. Addy et al., "TheDevelopment and in vitro Evaluation of Acrylic Strips and DialysisTubing for Local Drug Delivery", J. Periodontal 53, 693 (1982) usingacrylic strips 1 mm or more long, impregnated with chlorhexidine,tetracycline or metronidazole, which were inserted into the periodontalpocket with tweezers. Such a strip, formed from ethylcelluloseimpregnated with metronidazole, is disclosed by Loesche in U.S. Pat. No.4,568,538 (February 1986). Another strip, employing a water solublepolymer of a particular elasticity and viscosity, is disclosed by Suzukiet al. in U.S. Pat. No. 4,569,837.

In addition to the above approaches, the prior art also discloses usingputty-like compositions containing an antimicrobial for insertion intothe periodontal pocket. See U.S. Pat. No. 4,650,665, Mar. 17, 1987 toKronenthal et al., incorporated herein by reference.

The present inventor has discovered that using polypropenoic acid as thematerial forming the composition/device allows for efficient/gooddevices to be formed.

Previous attempts to effectively treat periodontal pockets have not beendesirably successful. This is largely due to the fact that a periodontalpocket cavity is very narrow and convoluted or tortuous, making itnearly impossible to fill the entire cavity with a treatment product.

This invention, utilizing highly swellable polymer eliminates suchproblems. Once a product of this invention is placed in periodontalcavity, the polymer swells, expands, and reaches narrow crevices andfurcations of the treated cavity, carrying active agent throughout thecavity. This provides most desirable efficacy at treatment site.

It is therefore an object of the present invention to providepolypropenoic compositions/devices suitable for treating periodontaldisease and other diseases of the oral cavity.

It is a further object of the present invention to provide suchcompositions/devices using mixtures of polypropenoic acid and otherpolymers.

It is still a further object of the present invention to provide amethod of treating periodontal disease.

All percentages and ratios used in here are by weight unless otherwiseindicated.

All measurements are made at 25° C. unless otherwise indicated.

SUMMARY OF INVENTION

The present invention relates to compositions/devices and methods fortreating diseases of the oral cavity by inserting thecompositions/devices around or into the periodontal pocket of humans andlower animals. The compositions/devices comprise polypropenoic acid andan agent providing relief of diseases of the oral cavity such asperiodontal disease.

DETAILED DESCRIPTION OF THE INVENTION

The essential as well as optional components of the compositions/devicesof this invention are described below.

Polymer

The polymer used in the present compositions is referred as superabsorbent polymer and is defined as polypropenoic acid. The material isa polyacrylic acid which is lightly crosslinked with an agent such asdivinyl glycol, trimethylpropane triacrylate and polyallyl sucrose.These materials are provided as Dry Tech 512 by Dow Chemical Company,Aqualac-CA by Nippon Shokubai and NALCO-1181 by Nalco Chemicals. Othermaterials related to the above include Polycarbophil by B. F. GoodrichCompany.

A preferred material is Dry Tech-512 which is polyacrylic acidcrosslinked with 0.004 mole percent of trimethylpropane triacrylate. Thecarboxylic groups can be neutralized with, for example, a sodium base toan extent of 75% or more.

A most preferred polymer useful in the present invention has very high,nearly infinite molecular weight in its crosslinked form which isestimated to be 2 million to 10 million or even higher. Unit segments ofcrosslinked polymer have a range of number average molecular weight fromabout 50,000 to about 1 million. The polymer is used in the presentcompositions at a level of from about 1% to about 99%, preferably fromabout 10% to about 75%, most preferably from about 20% to about 50%.

Drug Active

The drugs useful for use in the present compositions/devices are variedand many and include any agent which provides treatment of the disease.Some therapeutic agents which are amenable to delivery by this means andare potentially of value for periodontal therapy, include (but are notlimited to) antimicrobial/antibacterial agents such as iodine,sulfonamides, mercurials, bisbiguanides, or phenolics; antibiotics suchas tetracycline, neomycin, kanamycin, metronidazole, or clindamycin;antiinflammatory agents such as aspirin, naproxen, ibuprofen,flurbiprofen, indomethacin, eugenol, or hydrocortisone;immune-suppressive or stimulatory agents such as methotrexate orlevamasole; dentinal desensitizing agents such as strontium chloride orsodium fluoride; odor masking agents such as peppermint oil orchlorphyll; immune reagents such as immunoglobulin or antigens; localanesthetic agents such as lidocaine or benzocaine; nutritional agentssuch as amino acids, essential fats, and vitamin C; antioxidants such asalphatocopherol and butylated hydroxy toluene; lipopolysaccharidecomplexing agents such as polymyxin; or peroxides such as urea peroxide.It is recognized that in certain forms of therapy, combinations of theseagents in the same delivery system may be useful in order to obtain anoptimal effect. Thus, for example, an antibacterial and anantiinflammatory agent may be combined in a single delivery system toprovide combined effectiveness.

The drug active is used at a level of from about 1% to about 99%,preferably from about 5% to about 75%, most preferably from about 10% toabout 50% of the compositions/devices. The compositions/devices, forexample, are designed to release drug at a rate to provide concentrationof from about 10 μg to about 2000 μg, preferably from about 50 μg toabout 1000 μg, most preferably from about 100 μg to about 500 μg permilliliter of the gingival crevicular fluid of a treated periodontalpocket. Desired release rates can be achieved by altering ratios ofcomponents in a composition.

Optional Components

In addition to the drug active, the compositions/devices of the presentinvention may include a variety of optional components. Such componentsinclude, but are not limited to, surfactants, other polymers, viscositycontrolling agents, complexing agents, antioxidants, gums such as guargum, waxes/oils such as castor wax, castor oil, glycerol, dibutylphthalate and ethyl sebacate as well as many others.

The additional polymer may include a number of polymers such as methylcellulose, polycaprolactone and polylactide. A particularly preferredpolymer is a copolymer of lactide and glycolide. Lactide monomericspecies preferably comprise 15% to about 85%, most preferably from about35% to about 65%, of the polymers while glycolide monomers comprise fromabout 15% to about 85% of the polymer, preferably from about 35% toabout 65% on a molar basis. The molecular weight lies in the range offrom about 1000 to about 120,000 (number average). These polymers aredescribed in detail in U.S. Pat. No. 4,443,430, Apr. 17, 1984, to Matteiincorporated herein by reference.

If used, these optional components comprise from about 0.1% to about50%, preferably from about 0.5% to about 25% of the totalcomposition/device.

METHOD OF MANUFACTURE

Method of manufacturing the compositions/devices of this invention aredisclosed in the Examples.

The following Examples further describe and demonstrate the preferredembodiments within the scope of the present invention. The Examples aregiven solely for the purpose of illustration and are not to beconstructed as limitations of the present invention as many variationsthereof are possible without departing from its spirit and scope.

EXAMPLE I

The following is an exemplary composition/device of the presentinvention.

    ______________________________________                                                              Weight %                                                ______________________________________                                        Tetracycline hydrochloride                                                                            50                                                    Polypropenoic acid      22.7                                                  Poly(lactyl-co-glycolide)/50:50 copolymer                                                             22.7                                                  Propylene Carbonate     4.6                                                   ______________________________________                                    

The above composition can be prepared in a number of different ways. Oneway is as follows: Polymer is charged into 110° C., electrically heatedmixer, equipped with high shear Sigma type rotor blades. Propylenecarbonate is added and mixed into the polymer. The drug is added andmixed until uniform. The drug polymer blend is removed for furtherprocessing into desired size and shaped devices.

The compositions/devices of the invention of this application areinserted into or around the periodontal pocket or gingival region, andare administered in the form of a particle, film or sheet. The size,shape, and thickness can be changed according to the condition of theperiodontal disease to be treated and they are not particularlycritical. Ordinarily, the size, shape, and thickness are changedaccording to the size of the periodontal pocket of the patient or thecondition of the gingiva. The devices may be for example of a size suchthat the thickness is in the range of 0.01 to 2 mm, preferably fromabout 0.1 to about 1 mm; the width in the range of 0.1 to about 5 mm,preferably from about 0.2 to about 4 mm; and the length in the range offrom about 1 to about 15 mm, preferably from about 3 to about 10 mm.

EXAMPLE II

Given below is another composition/device of the present invention:

    ______________________________________                                                         Wt. %                                                        ______________________________________                                        Chlorhexidine acetate                                                                            40                                                         Polypropenoic acid 35                                                         Methyl Cellulose   20                                                         Glycerol monostearate                                                                             5                                                         ______________________________________                                    

EXAMPLE III

Given below is still another composition/device representative of thepresent invention:

    ______________________________________                                                        Wt. %                                                         ______________________________________                                        Metronidazole     40                                                          Polypropenoic acid                                                                              30                                                          Polycaprolactone  25                                                          Pluronic F-68      5                                                          ______________________________________                                    

EXAMPLE IV

Given below is still another composition representative of the presentinvention:

    ______________________________________                                                        Wt. %                                                         ______________________________________                                        Flurbiprofen      20                                                          Polypropenoic acid                                                                              25                                                          Xanthan Gum       20                                                          Polylactide polymer                                                                             25                                                          Polyethylene glycol                                                                             10                                                          ______________________________________                                    

What is claimed is:
 1. A composition suitable for insertion into or around the periodontal pocket of a person or lower animal suffering from diseases of the oral cavity consisting essentially of polypropenoic acid crosslinked with less than about 0.004 mole percent of crosslinking agent and a drug active suitable for treating said diseases.
 2. A composition according to claim 1 wherein the drug active is selected from the group consisting of antiinflammatory agents.
 3. A composition according to claim 2 wherein the concentration of drug active is from about 5% to about 75%.
 4. A composition according to claim 3 wherein the concentration of the drug active is from about 10% to about 50%.
 5. A composition according to claim 3 which in addition contains another polymer.
 6. A composition according to claim 5 wherein said additional polymer is a copolymer of glycolide and lactide.
 7. A method of treating periodontal disease in a person or lower animal suffering from such disease by placing a composition according to claim 1 into/around the periodontal pocket of said person or lower animal.
 8. A method according to claim 7 wherein the composition has a polypropenoic acid concentration of from about 1% to about 99%.
 9. A method according to claim 8 wherein the drug active is selected from the group consisting of antiinflammatory agents.
 10. A method according to claim 9 wherein the composition is formed into a shape having a width of from about 0.1 mm to about 5 mm, a thickness of from about 0.01 mm to about 2 mm and a length of from about 1 mm to about 15 mm. 